With the expanded insurance coverage of the Patient Protection and Affordable Care Act, it's an open question as to whether emergency department volumes will go up or down. Dealing with over-capacity emergency services, however, is not a problem limited to the insurance expansion arena. For facilities that are in need of an update, capacity management can be a significant barrier to quality care.
Leigh Valley Hospital-Mullenberg, based in Bethlehem, Pa., encountered this very problem with its ED, according to an article authored by the hospital's director of emergency medicine, John F. Wheary, DO, MBA, published in .
The 23-bed ED, originally built in 1994, was designed to accommodate 30,000 patients annually. But by 2010, the ED was seeing nearly two times that number, 52,000 per year.
To improve efficiencies in the ED, LVH-M sought to improve use of both space and operations. It did so through constructing rapid assessment units, a model in which patients are sorted at intake and provided with immediate treatment, if applicable.
The RAUs allowed the ED team to drastically decrease wait times for patients — from 60 minutes down to an average of 20 minutes — while improving the speed and accuracy of ED care for each patient, keeping beds freer for patients who benefit most from the beds.
Another aspect of capacity management at LVH-M was making better distinctions between patients who could remain upright and those who should be placed on stretchers. By eliminating recumbent patients who could actually stand, the building is now able to accommodate more patients per square foot than traditional EDs, according to the report.
Through the use of patient sorting and RAUs, LVH-M increased ED capacity 5 percent, decreased the percentage of patients who leave without being seen from 2.4 percent to 0.2 percent, decreased length of stay, decreased ambulance diversion from 700 hours to zero hours per year and increased patients satisfaction scores from the 40th to the 90th percentile.
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